Neurological Complications after Coronary Artery Bypass Grafting for High-Risk Patients: Current State of the Problem

Keywords: stroke, CABG, off-pump, high-risk patients, neurological dysfunction


Neurological disorders are the most serious and debilitating complications of the postoperative period in cardiac surgery. The main clinical manifestations of cerebral dysfunction are as follows: stroke, decreased cognitive function, encephalopathy and depressive disorder.

The aim. To perform a literature review of neurological complications after coronary artery bypass grafting (CABG) in high-risk patients.

Results. The main neurological complications after CABG in high-risk patients were considered. The main pathophysiological mechanisms of development of cerebral circulation disorders in the form of macro- and microembolization, hypoperfusion secondary to hypotension and systemic inflammatory response have been determined. According to the literature, the incidence of stroke in the postoperative period is 1.5–6%, and it increases in the elderly. It’s important to perform carotid arteries ultrasound before CABG. According to the literature, carotid stenosis greater than 60% is found, depending on the age group, in 7–12% of patients. There is an ongoing debate around the world regarding the method and time of carotid atherosclerosis surgery (before revascularization, during or after CABG). Newman and co-authors have shown that in 5 years after myocardial revascularization, 41% of patients have a decrease in cognitive function, and it is lower than it was before surgery. Opponents of on-pump CABG have hypothesized the occurrence of Alzheimer’s disease after surgery with extracorporeal circulation, but authors from Mayo Clinic have investigated this question and refuted this theory; Canadian researchers have even proved the positive effect of revascularization on prevention of Alzheimer’s disease. The main strate­ gy for the prevention of cerebral complications is an individual approach for each high-risk patient.


  1. Raffa GM, Luca A, Badhwar V, Pilato M. International participation in the Society of Thoracic Surgeons database improves outcomes: initial Italian experience. Ann Thorac Surg. 2016;101(5):2028–9.
  2. Raffa GM, Kowalewski M, Brodie D, Ogino M, Whitman G, Meani P, et al. Meta-analysis of peripheral or central Extracorporeal Membrane Oxygenation in Postcardiotomy and non-Postcardiotomy shock. Ann Thorac Surg. 2019 Jan;107(1):311–321.
  3. Hueb W, Lopes NH, Pereira AC, Hueb AC, Soares PR, Favarato D, et al. Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III Trial. Circulation. 2010;122(11 Suppl):S48–S52.
  4. Møller CH, Perko MJ, Lund JT, Andersen LW, Kelbaek H, Madsen JK, et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the Best Bypass Surgery Trial. Circulation. 2010;121(4):498–504.
  5. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, Piegas LS, Avezum A, Akar AR, Lanas Zanetti F, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Gao P, Pettit S, Yusuf S; CORONARY Investigators. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med. 2016;375(24):2359–68.
  6. Ho PM, Arciniegas DB, Grigsby J, McCarthy M Jr, McDonald GO, Moritz TE, et al. Predictors of cognitive decline following coronary artery bypass graft surgery. Ann Thorac Surg. 2004;77(2):597–603.
  7. Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol. 2004;44(5):e213–e310.[Erratum in: J Am Coll Cardiol. 2005;45(8):1377.]
  8. Floyd TF, Shah PN, Price CC, Harris F, Ratcliffe SJ, Acker MA, et al. Clinically silent cerebral ischemic events after cardiac surgery: their incidence, regional vascular occurrence, and procedural dependence. Ann Thorac Surg. 2006;81(6):2160–6.
  9. Baker RA, Hallsworth LJ, Knight JL. Stroke after coronary artery bypass grafting. Ann Thorac Surg.2005;80(5):1746–50.
  10. Bouchard D, Carrier M, Demers P, Cartier R, Pellerin M, Perrault LP, et al. Statin in combination with β-blocker therapyreducespostoperativestrokeaftercoronaryartery bypass graft surgery. Ann Thorac Surg. 2011;91(3):654–9.
  11. Durand DJ, Perler BA, Roseborough GS, Grega MA, Borowicz LM Jr, Baumgartner WA, et al. Mandatory versus selective preoperative carotid screening: a retrospective analysis. Ann Thorac Surg. 2004;78(1):159–66.
  12. Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, Isayev Y, et al. Strokes after cardiac surgery and relationship to carotid stenosis. Arch Neurol. 2009;66(9):1091–6.
  13. Millar K, Asbury AJ, Murray GD. Pre-existing cognitive impairment as a factor influencing outcome after cardiac surgery. Br J Anaesth. 2001;86(1):63–7.
  14. Jensen BO, Hughes P, Rasmussen LS, Pedersen PU, Steinbrüchel DA. Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial. Circulation. 2006;113(24):2790–5.
  15. Nakamura Y, Kawachi K, Imagawa H, Hamada Y, Takano S, Tsunooka N, et al. The prevalence and severity of cerebro-vascular disease in patients undergoing cardiovascular surgery. Ann Thorac Cardiovasc Surg. 2004;10(2):81–4.
  16. Kozora E, Kongs S, Collins JF, Hattler B, Baltz J, Hampton M, et al. Cognitive outcomes after on- versus off-pump coronary artery bypass surgery. Ann Thorac Surg. 2010;90(4):1134–41.
  17. Knopman DS, Petersen RC, Cha RH, Edland SD, Rocca WA. Coronary artery bypass grafting is not a risk factor for dementia or Alzheimer disease. Neurology. 2005;65(7):986–90.
  18. Mutch WA, Fransoo RR, Campbell BI, Chateau DG, Sirski M, Warrian RK. Dementia and depression with ischemic heart disease: a population-based longitudinal study comparing interventional approaches to medical management. PLoS ONE. 2011;6(2):e17457.
  19. Price CC, Garvan CW, Monk TG. Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology. 2008;108(1):8–17.
  20. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395–402. [Erratum in: N Engl J Med. 2001;344(24):1876.]
  21. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand. 2010;54(8):951–6.
How to Cite
Gogayeva, O., Rudenko, A., & Lazoryshynets, V. (2020). Neurological Complications after Coronary Artery Bypass Grafting for High-Risk Patients: Current State of the Problem. Ukrainian Journal of Cardiovascular Surgery, (2 (39), 15-17.